Provider Demographics
NPI:1033483482
Name:ASADI, ALI JON (DPT, MTC, CSCS)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:JON
Last Name:ASADI
Suffix:
Gender:M
Credentials:DPT, MTC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-1330
Mailing Address - Country:US
Mailing Address - Phone:309-852-2200
Mailing Address - Fax:
Practice Address - Street 1:110 E 10TH ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-1330
Practice Address - Country:US
Practice Address - Phone:309-852-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005355225100000X
CO11128225100000X
IL070021281225100000X
NCP12937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist